EFFICACY OF SEPTOPLASTY VERSUS MEDICAL MANAGEMENT FOR NASAL OBSTRUCTION IN, MODERATE NASAL SEPTAL DEVIATION

Abstract

Introduction: Nasal obstruction/ blockage is a common ailment that significantly lowers the quality of life. One of the main cause for symptoms like congestion, headaches, and postnasal dripping is due to a deviated nasal septum (DNS), which can also impede airflow and cause above mentioned symptoms. A cautious medication care with intranasal corticosteroids and decongestants, and surgical rectification with septoplasty are the two main management modalities. For mild septal abnormalities, there is ongoing discussion on the best course of action. In this study, to compare the efficacy of septoplasty against medical therapy in patients with moderate septal deviation, patient outcome based on NOSE score and symptoms relief are studied.

Objective: The objective of this study is to compare the results of medical therapy and septoplasty in reducing nasal obstruction brought on by moderate deviated nasal septum (DNS) and to analysis which of the type of treatment is more effective. Using symptom remission Nasal Obstruction Symptom Evaluation (NOSE) scores over a follow up period of six Months (06 x months) to assess the patient outcome. The study also aims to carryout comparison between global viewpoints on DNS management and highlight the cultural, economic, and social elements that effect treatment choices, especially in Pakistan.

Methods: This study was carried out in PNS Shifa Hospital in Karachi, Pakistan. In this study, pre and post operation/ medical treatment data of 80 x patients ranging in age from 18 to 68 were analyze. The two treatment approaches used to categorize the participants i.e surgical septoplasty (group) and medicinal management (conservative group). To record the severity of symptoms, the Nasal Obstruction Symptom Evaluation (NOSE) score was used and Cottle's classification was used to determine the severity of DNS and Cottles II (Mild DNS) patients were segregated and further results of patients with mild DNS (30 x Patients) was manage through medical (15 x patients) and surgical septoplasty (15 x Patients). At baseline and six months after therapy, follow-ups were carried out. To compare the outcome of medical and surgical efficacy statistical data on patient record forms were noted and compared by using statistical methods like paired t-tests and chi-square.

Results: Patients who underwent septoplasty demonstrated significant improvements in nasal obstruction, with NOSE scores decreasing from a mean of 38.6 (pre-treatment) to 9.7 (post-treatment). The medical management group exhibited limited improvements, with post-treatment NOSE scores remaining elevated at 15-30. Patients in surgical group reported significant improvement rate. The most common symptoms addressed were nasal obstruction (100% of cases), headache (47%), and postnasal dripping (37%). In medical group, only 33% of patients achieved significant improvement, while 67% had persistent symptoms (e.g., nasal obstruction, headaches).Headaches persisted in 50% of medical group patients who initially reported them, suggesting multifactorial etiology beyond nasal obstruction. Statistical analysis confirmed that septoplasty provided superior long-term relief (p<0.001).

Conclusion: Septoplasty is more effective than medical management in alleviating nasal obstruction caused by moderate DNS. While medical therapy may offer short-term relief, it does not provide substantial long-term improvements. Patients with persistent symptoms, should be prioritized for surgical intervention instead of medical management.